ConnectiCare Preauthorization Requirements (Commercial)

This list applies to ConnectiCare’s members with commercial benefit plans. It contains notification/preauthorization requirements for inpatient and outpatient services.

Updates to this list will be communicated through the Revision History sections and the provider newsletters.

Note: Some services may be benefit exclusions for some of our ConnectiCare Plans. Please verify member eligibility and benefits.

ConnectiCare Preauthorization Requirements (Medicare)

This list applies to ConnectiCare’s members with Medicare benefit plans. It contains notification/preauthorization requirements for inpatient and outpatient services.

Updates to this list will be communicated through the Revision History and the provider newsletters.

Note: Some services may be benefit exclusions for some of our ConnectiCare Plans. Please verify member eligibility and benefits.

ConnectiCare Pharmacy Preauthorization List

Use this list to see the drugs that are associated with the member’s medical benefit.

Drug Preauthorization List

Use this list to see drugs that must meet clinical criteria in order to be covered under the member’s medical or pharmacy benefit.

Home Infusion Therapy Drug Preauthorization List

Use this list to see which home infusion therapy drugs require preauthorization.

Specialty Drug Preauthorization List

Use this list to see which drugs require preauthorization as part of the Specialty Pharmacy Program. Most drugs should be filled by a specialty pharmacy and are limited to a 30-day supply. ConnectiCare’s preferred Specialty Pharmacy is Accredo.